高龄妊娠期糖尿病患者血清m...产后糖代谢异常的相关性研究_张东方.pdf

66现代检验医学杂志第 38 卷第 1 期2023 年 1 月J Mod Lab Med,Vol.38,No.1,Jan.2023高龄妊娠期糖尿病患者血清 miR-351，FGF19 和 LP-PLA2 表达水平及其与产后糖代谢异常的相关性研究张东方,王茜,李娟,庄敏敏（唐山市妇幼保健院产科，河北唐山 063000）摘要：目的探讨高龄妊娠期糖尿病（gestational diabetes mellitus，GDM）患者微小核糖核酸（micro RNA，miR）-351，纤 维 细 胞 生 长 因 子 19（fibroblast growth factor 19，FGF19），脂 蛋 白 相 关 磷 脂 酶 A2（lipoprotein-associated phospholipase A2，LP-PLA2）表达及与产后糖代谢异常的相关性。方法选取 2019 年 1 月 2022 年 1 月唐山市妇幼保健院高龄 GDM 患者 86 例为观察组，同期选取产检的正常高龄孕妇 52 例为对照组。比较两组血清 miR-351，FGF19 和LP-PLA2 表达，分析高龄 GDM 患者 miR-351，FGF19 和 LP-PLA2 与产后糖脂代谢指标相关性，Logistic 回归分析高龄GDM 患者产后糖代谢异常影响因素，受试者工作特征（ROC）分析 miR-351，FGF19 和 LP-PLA2 对产后糖代谢异常预测价值。结果观察组血清空腹血糖（FPG）（5.930.61mmol/L），空腹胰岛素（FINS）（15.824.19mU/L）,胰岛素抵抗指数（MOHA-IR）（4.310.64）,三酰甘油（TG）（1.460.28mmol/L），低密度酯蛋白-胆固醇（LDL-C）（2.930.66mmol/L），miR-351（6.421.76），LP-PLA2 活性（33.096.51nmol/minml）高于对照组（4.480.76mmol/L,11.653.90m/U/L，2.450.57,1.320.24mmol/L，2.580.59mmol/L，3.791.14，24.525.83nmol/min ml），而FGF19（91.188.64ng/L）水平低于对照组（122.6310.29ng/L），差异均有统计学意义（t=2.99917.226，均 P 0.05）；高龄 GDM 患者血清miR-351 水平、LP-PLA2 活性与空腹血糖（fasting plasma glucose，FPG）、空腹胰岛素(fasting insulin，FINS)、胰岛素抵抗指数（insulin resistance index，HOMA-IR）、三酰甘油（triglyceride，TG）和低密度脂蛋白-胆固醇（low density lipoprotein，LDL-C）呈正相关（r=0.408 0.584，均 P 0.05），血清 FGF19 水平与 FPG，FINS 和 HOMA-IR 呈负相关（r=-0.614 -0.386，均 P 0.05）；高龄 GDM 患者 miR-351 与 FGF19 呈负相关（r=-0.531，P 0.001），与 LP-PLA2呈正相关（r=0.549，P0.001），FGF19与LP-PLA2呈负相关（r=-0.614，P0.001）。Logistic回归模型分析显示，miR-351，LP-PLA2活性升高及FGF19降低均为高龄GDM患者产后糖代谢异常独立危险因素（P0.05）；ROC曲线显示，miR-351，LP-PLA2 和 FGF19 对 GDM 患者产后糖代谢异常均有一定预测价值，且联合预测的 AUC 达 0.854，对应的敏感度和特异度分别为 90.16%和 68.35%。结论血清 miR-351，FGF19 和 LP-PLA2 参与 GDM 发生发展，可对患者体内糖脂代谢产生影响，且可有效预测产后糖代谢异常发生风险，为临床干预提供依据。关键词：高龄孕妇；妊娠期糖尿病；微小核糖核酸-351；纤维细胞生长因子 19；脂蛋白相关磷脂酶 A2中图分类号：R714.256；R392.11文献标识码：A文章编号:1671-7414（2023）01-066-07doi:10.3969/j.issn.1671-7414.2023.01.013Serum miR-351,FGF19 and LP-PLA2 Expression Levels in Elderly Patients with Gestational Diabetes Mellitus and Their Correlation with Abnormal Postpartum Glucose MetabolismZHANG Dong-fang，WANG Qian，LI Juan，ZHUANG Min-min（Department of Obstetrics,Tangshan Maternal and Child Health Hospital,Hebei Tangshan 063000，China）Abstract:ObjectiveTo investigate the microRNA(miR)-351,fibroblast growth factor 19(FGF19)and lipoprotein-associated phospholipase A2(LP-PLA2)in elderly patients with gestational diabetes mellitus(GDM)expression and its correlation with abnormal postpartum glucose metabolism.MethodsFrom January 2019 to January 2022,86 elderly patients with GDM in Tangshan Maternal and Child Health Hospital were selected as the observation group,and 52 normal elderly pregnant women who underwent obstetric examination in the hospital during the same period were selected as the control group.The clinical characteristics and serum miR-351,FGF19 and LP-PLA2 expressions were compared between the two groups.The correlation between miR-351,FGF19,LP-PLA2 and postpartum glucose and lipid metabolism indexes in elderly GDM patients was analyzed.Logistic regression was used to analyze postpartum glucose metabolism abnormalities in elderly GDM patients.基金项目：河北省医学科学研究课题计划项目（20221770）。作者简介：张东方（1975-），女，硕士，主治医师，研究方向：妊娠期糖尿病，E-mail：。67现代检验医学杂志第 38 卷第 1 期2023 年 1 月J Mod Lab Med,Vol.38,No.1,Jan.2023Influencing factors,receiver operating characteristic(ROC)analysis of the predictive value of miR-351,FGF19 and LP-PLA2 for abnormal postpartum glucose metabolism.ResultsFasting plasma glucose（FPG）of observation group(5.930.61mmo/L vs 4.480.76mmol/L),fasting insulin(FINS)(15.84.19mU/L vs 11.653.90m/U/L),insulin resistance index(HOMA-IR)(4.310.64 vs 2.450.57),triglyceride(TG)(1.460.28mmol/L vs 1.320.24mmol/L),low density lipoprotein-C(LDL-C)(2.930.66mmol/L vs 2.580.59mmol/L),serum miR-351(6.421.76 vs 3.791.14),LP-PLA2 activity(33.096.51nmol/minml vs 24.525.83nmol/minml)was higher than the control group,FGF19 level(91.188.64ng/L vs 122.6310.29ng/L)level was lower than the control group,the differences were statistically significant(t=2.99917.226,all P 0.05).Serum miR-351 level and LP-PLA2 activity in elderly patients with GDM were positively correlated with FPG,FINS,HOMA-IR,TG and LDL-C(r=0.408 0.584，all P 0.05).Serum FGF19 level was negatively correlated with FPG,FINS,HOMA-IR(r=-0.614-0.386，all P 0.05)，miR-351 was negatively correlated with FGF19 in elderly GDM patients(r=-0.531,P 0.001).It was positively correlated with LP-PLA2(r=0.549,P0.001),and FGF19 was negatively correlated with LP-PLA2(r=-0.614,P 0.001).Logistic regression model analysis showed that HOMA-IR,miR-351 and LP-PLA2 activity and decreased FGF19 were independent risk factors for postpartum abnormal glucose metabolism in elderly GDM patients(P0.05).Value and the AUC of the joint prediction was 0.854,the corresponding sensitivity and the specificity was 90.16%and 68.35%,respective.ConclusionSerum miR-351,FGF19 and LP-PLA2 are involved in the occurrence and development of GDM,which can affect the glucose and lipid metabolism in patients,and can effectively predict the risk of abnormal postpartum gluco